Updates to oncology and hematology prior authorization codes for many plans

Effective Oct. 1, 2024, we’ll require prior authorization for specific services administered in outpatient settings as treatment for oncologic or hematologic conditions. This applies to the Healthcare Common Procedure Coding System (HCPCS) codes in the following table.

We’re making this change to reflect the new codes introduced by the Center for Medicare & Medicaid Services in recent HCPCS code updates. Please note that J1323 is a replacement code for discontinued code C9165.

Codes this applies to

Plans this applies to

These changes affect UnitedHealthcare® Medicare Advantage and UnitedHealthcare commercial plans in all states. For UnitedHealthcare Community Plan and UnitedHealthcare Individual Exchange plans,* changes apply to the following states:

Questions?

For questions about oncology prior authorization:

• Email unitedoncology@uhc.com
• Visit our Oncology Prior Authorization and Notification page
• Call oncology prior authorization support at 888-397-8129

*Also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans

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